HomeMy WebLinkAboutSLEEPY HOLLOW #2 BLK 1 LT 21
'~'AME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVlRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl.. SYSTEM AND/OR WELL INSPECTION REPORT
HR-~o
MAILIN6 ADDRESS
LEGAL DESCRIPTION
L2_i
LOCATION
Well
DISTANCE TO: I
Manufacturer
apacit¥ in gallons
IF HOMEMADE:
Well
DISTANCE TO: ~A~c)r' _.~'~1,/¥~,'r'
No, of lines / I Length of each
Top ofdleto finish grade ~ · :~
Width
$ L~5. P% b~,o L. LO_kJ
IAbsorption area ~. ·
Inside length
Dweging
Foundation Z~,.
Total length o~s/~
Material beneath tile
Depth
Materia~,[~ ~ ~.
Material
N0arest lot line ~. ~. -
Trench widtl
NO. OFBEDROOMS
PERMIT NO. ~2 I ~*~Z
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO. ~:~Z/,~ / ~
Distance b e t wee.~T¢~,]
Total e, f e c~,~___~/p t~ a r e a
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot llne PERMIT NO.
DISTANCE TO: Septic tank - ~s~ea(s)
OTHER
PIPE MATERIALS
INSTALLER
REMARKS
APPBOVED//
72-0/1'3 (Rev. 3/78)
DATE LEGAL
PERMIT
DEPFIF.'.TMEWT OF HEHLTH RND ENV]RONHENTHL PF'.OTECT]ON
825 "'L
2G4-47~0
[~IELL. fl['~[]) ~]]t4--S I TEE SDTI-41D:E: f)EF~r4 I "F
( 821012 )
fPPLICFINT
LOC~TION
LEGHI_
HRROLD D GROSS
L.2± Bi SLEEPY HOLLOW
:~4422 BOBBIE CIR
LOT SIZE
:'t44.-..52264
999999 SQURRE FEET
TYPE OF SOIL RBSORPTION SYSTEM IS: DRFIINFIELD
MFI~Ih'IUbl NUMBER OF BEDROOMS
SOIL RFITING (S~! FT/BR)= i25
THE REL':AJIRED SIZE OF THF SOIL RBSORP'TION SYSTEM IS:
~EP]'H= 9 LE~-4GTHI= 41
D E F~ T ~'-~ := 1:':. -5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD.
THE DEPTH OF FI TRENCH OR F'IT IS THE DISTFINCE BETHEEN THE: SURFFIE:E OF' ]"HE
GROUND FIND THE BOTTOM OF THE EXCFIVFITION (IN FEET).
]"FIE TREI"-.I~Z:H bi I [)TH I S 5. O~-]'~:z]~ FEET'.
THE GRFIVEL DEPTH IS ]'HE MINIMUM DEPTH OF GRRVEL BETHEEN THE OLITFBLL PIPE:
FII'.ID THE BOTTOM OF THE EXCFIVFITION (IN FEET).
PERMIT RPPLIC:RNT HFIS THE RESPONSIBIL. IT¥ 'rD INFORM 'THIS DEPFIRTMENT DURING THE
INSTI~LLRTION INSPECTIONS OF RN¥ HELLS RDJFICENT TO THIS PROPER'PT' FIND THE
NUMBER OF RESIDENCES THFIT THE WELL HILL SERVE.
T'b~O ( 2 ::, I I'-tSPEEC:T I 01'-I--~;-. F:I F."E RIS~-~LI ][
BfCKFILLING OF FINY S"?STEM HITHOUT FINFIL INSPECTION FIND FIPPROVFIL BY THIS
DEF'FIRTMENT HILL BE SUBJP. CT TO PROSECUTION.
MINIMUM DI':::TRNCE BE'rHEEN FI WELL. RND RN¥ ON-SITE SEWFIGE DISPOSRL SYSTEM IS
lElO FEET FOR FI PRIVFITE WELL OR 150 TO 200 FEET FROM FI PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC HELL
MINIMUM DISTFINCE FROM FI PRIk'FITE HELL TO FI PRIVFITE SEWER LINE IS 25 FFET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
HELL LOGS FiRE REQUIRE[:, RND MUST BE RETURNED TO THE DEPFIR. TMENT WITHIN 220
OF THE HELL COMPLETION.
OTMER REQUIREMENTS MF]Y FIPPL'¢. SPECIFICRTIONS FIND COI'qSTRUCTION DIFIGRI:IMS FIRE
FIVRIL. FIBLE TO INSURE PROF'ER INSTFILLFITION.
F:'Ei'4~I'.'I I T [-Z.'-'~: P I: I~:ES [)E~]EI"IBER ~ :t..,
I CERTIF"r' ]'HFIT
t: I FIb1 FFIMILIFIR HITFI THE REQUIREMENTS FOR ON-SITE SIEWERS fiND HELLS I-'IS SET
FORTH BY THE MUNICIPFtLIT9 OF RNCHORFIGE.
2: I WILL INSTFILL THE S9STEM IN BCCORDFINCE HITH THE CODES.
22: I I..INDERSTFIND THFIT THE ON-SITE SEWER SYSTEM MFI"r~ REL=.!UIR. E ENL~RGEMENT IF' THE
RES IDENC~MOD~LE~ 'F~CLLIi)E MCIR, E THRN 22 BEDRC'OMS.
.............
c_ /7
CONSTRUCTION
TEST I_AB
Barold Gros~
~ERFORMED FOR,
LEGAL DESCRIPTION: Lo1 21 Black
THIS FORM REPORTS: ~Visual Soils Examination
18~9 W 48T1-1 AVE STE. 'C'
A~,,JHORAGE, ALASKA 9950:5
248-1333
DATE PERFORMED~
Subdivision S 1 e_~.py_ Ho ! ~ ow
D Percolotion Test
zo/3o/s1
DEPTH SOIL
--EET DESCRIPTION NOTES
Silty Sand - SM
2'
Sandy Gravel - GP
9'
Gravelly Silt - GM
14'
BOTTOM OF HOLE
ENCOUNTERED NO ,' .... , .
zl .
,'.'AS GROUND WATER ;,(,, ,, ,:: ..,., ,;., I
~S- Sample loken
= -- Frozen zone ':},-. : : , , . ,
~-- Woler loble "',, ' ' , .
GENERAL BITE SLOPE
=EADING DATE GROSS TIME NET TIME DEPTH TO H20 NET DRAINAGE
I
DRAINAGE REOUIREMENTS: 125 SF/bedroom_~.~,.;
\"";'?~2 t,
E) DRAIN FIELD [3 OTHER
DATE:
:-ERCOLATION RATE:
: ROPOSED INSTALLATION:
COMMENTS:
SEEPAGE PIT
ZEST PERFORMED BY: Kevin Braun
SCALE
Ih'il ILjt Ih,dl ~E ir'2:2 :E IF:':" ,¢::'-'~ L~
DIEF:'ARTMIEI',IT OF hlIEAI_.TH AND ENV):I][)I'4MEIM-I~AL F'ROTECTICIi',I
8,'::.!5 L !3]"F~IEEI', AIq(]HE)I:',~ABE, Al'::: 9950 .i,
PI?'f:~M I T
DA'I'E
~:~40786
09/17184
AF:'I::'L I CAN1":
ADDFIESS ~
'CON'I"~[;'I" F'HONE:
ANTHONY J,, SF:'ANGI...E~R
I:::',, 0,, BOX ~;:].";
[;HUGIAI'(, Al< 99567
;;;~6 6 - 1546
L. EGAL.
LOT S:i: ZIE:~
SLIBDIVISION: SLE;EF:'Y HOL. I...(]I4 ~$R L.(]T~ 2:[
SEC'TIOI~,I: :[SN 'T'E)WI',ISt"I:I:F'.':I. SN RANGE: :IW
lA (El(;!., F'"l" ,, OR ACR!rTz~ )
BLOI]K: 1
I cer't, iFy 'Lhat:
1. i am £amiliaP
fcir"t.h by 't. he Munic:ipali'Ly oF Anchor'age (MO~) and the State cH' Alaska,,
:[ will. instal], the sy~:uLem in ac::Col~darlc:e with a].l M[IA cc)des and pegtz].a't.:J, orl!?~,
arid J.n comp].J, ance ~i'Lh 1:he des:i, gn cr':i, ter'ia of this per'mi'L,,
I w:i. ll adhepe to all MOA ,ar'id State cH' Alaska r,(:~qu:i. Pements Fcm the c,e)H'., bacl.::
dis'Lances Fr'om any exis'Ling well, wastewa'Ler' disposal sws{em of public
sew~page system (~n this o¢ any adjac:ent r4p near'by
S I GNED DA t ......
AF F L.:I;CANT.' AN.~c'~3N¥ J. SF:'Ar,.IGI...EI-q '
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological I~ Geophysical Surveys
Drilling Permll No,
LOCATION OF WELL (Please complete either lo, lb or lc,) A,D.L, No,
SjJ
vision Lot BI ck I/4qtrs. Section No. TownshiPN[~ Ronge EF--I Merldlen
9A L--eL. of--of -- s~ w~
<- ' -. ~Rolery ~ Driven ~ Dug
, , .-, ., . ~,.;- ~,.I,,
.L-~,~,~ Si l~ t/% I"L?*)._ ~,,~. ,.. ,~,,. ~.,,~ ~,,,,,, '-'. ,,.
~._~_~.~m~"' __ /:?:~- /'~(;" .. ~,..~. o~ w~:
D ~ ~O~C rIO~ ~ Above or ~ Below land surface Date
--- 3
15. Wofor Temperoture ~ ~ F ~ C
Street Address und
WELL LOG
16, WATER WELL
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEW~::R AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcell. D.# ~"'1~/- /~ -~}¢..~ HAA# ~:\ ¢'~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 21; Block I; S16~p~ Hollow Subdivision #2
Location (address or directions)
18446 Mountain Road
(b) Property owner H.U.D. # 054681
Mailing Address
Telephone: (home)
Business
(c) Lending Institution
Mailing Address
Telephone
(d) RealEstate Company and Agent ASSOCIATED BROKERS ATTN: Sandy
Address 640 W~st $6th Ave~u&, Suit6 #I Ancho&a~6, Alaska 99503
Telephone 563-3333
(e) Mail the HAA to the following address: (or check here.I;~, if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 Eagle River Loop Road No, 204
Eagle River; AI~A~ ~79,~'~
2. TYPE OF RESIDENCE
Single-FamilyX~ Number of bedrooms 2
3. WATER SUPPLY
Individual WellY~~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4, SEWAGE DISPOSAL
On-site I~x Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status,
72-025 (Rev. 7/88) Page 1 of 2
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CttEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I,D, #92-0040440
ANALYSIS RE?OgT BY 3AI~LE for Work Orde~ ~ 27777
Date Report P~inted: OCT 4 90 0 16:03
Client Sample ID:L21 BI SLEEPY HOLLOW~2
TWSID :UA
Collected OCT S 90 ~ 21:40 hrs.
Received OCT ~ 90 @ l$:~E h~s.
PresorYed with :AS REQUIRED
Client Name : S & S ENGINEERING
Client Acct : SNSENGP
P.O.$ NONE RECEIVED
Req #
Ordered By : R. SHAFER
Analysis Completed :OCT 3 90 Send Reports to:
Laboratory Supervisor :STEPHEN C. EDE I)S ~ S ENGI}IEERING
Special
Instruct:
Chemlab gel t: 904042 Lab Smpl ID: I Natrix: MATER
Allowable
Parameter Tested Result Unit~ I~ethod Limita
NITRATE-N ND(O.iO) ms/1 EPA ~$~.2 10
Sample ROUTINE SABLE.
Remarks: SAMPLE COLLECTED BY RAY.
Tests Performed See Special Instructions Above UA=Unavailable
None Detected "See Sample Remarks Above
Not Analyzed LT=Lesa Than, GToGreater Than
MUNICIPALITY OF ANCHORAGE.
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEAl. TH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEAl. TH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (in~de lot, blo. c~, ,s~ubdivision, ~e_ction, to,reship, range)
Location (address or directions)
(c)
(d)
(e)
Applicants Name~~~ ~/~_/ Telephone- Home Business
Applicant is (check one) Lending Institution ~-~ ; Owner/builder~;
Buyer ~--~ ; 0ther~ (explain);
Lending Institution
Address
Real Estate Co. & Agent
~ ~ ,~ f-~ Te!ephon. e
Address
(f)
Telephone
~M~'~/-"~the HAA to the following' address:
2. Type of Residence
Single-Family~
Number of Bedrooms
Multi-Family~
Other ~describe)
3. Water Supply
Individual Well~' Community ~-~ Public ~
Note: If community well system~ must have written confimnation from the State
Department of Environmental Conse[~ation attesting to the legality and status.
4. Sewage Disposal.
Note: If community well system~ must have written confirmation from the State
Department of Environmental Conse~ation attesting to the legality and status.
[Page 1 of 2]
5. .~Dgineering Firm Providing Inspections~ Tests~ File Search~ Data and Information
e
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with ~.1 ~nicipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm ~
Address ::~.,~ .~ ~V~ AL~8~ -~5'f~
Telephone
ENGIHEER SEAL)
.I)HEP Approval
Appr~v~dfor'~t-~z~[~ bedrooms
Approved ____ ,' Disapproved
Conditional
Terms of Conditional Approval J~-~';(-r~Al~/4 /~ ' /qo~,~. ,,~l~f"K', ~'~$"/~.~
CAUTION
TItE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. TH]~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
~ENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~MALYZE DATA BEFORE AI
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT P~SPONSIBLE~ FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/eJ/D18
[Page 2 of 2]
7-19--84
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALII4 AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
MUNICIPALITY OF ANCHORA(.JI~
DEPT. OF HEALTH
I~NVIRONMENTAL PROTECI'IOI~]
DEC 2 O lg84
Well Classification
Well
Log Present{(~)~... .
Total D~pth k~y~5~ / . Ca~d to
Static Water ~1 //~
Casing Height ~ Ground
Electrical Wiring in Conduit<~)
Sep~ation Distance fF~ ~11:
To ~ptic/~f~ank on ~t
To ~arest Edge of ~sorption Field on
To Newest Public F~ Line
RECEIVEI)
gz 8i
Appr eve d ( Y/N F.
Date Completed , ?/~ ~ Yie_~].~'_~6~
' '
~pth of Grouting
PU~ ~t: At ~ ~
Sanit~y ~al on Casing~
~pression ~ound ~l~ead ~)
; On Adjoining Lots
; On Adjoining Lots.
~f/F~ To Nearest PUblic Sewer
Cleanout/Manhole ~7/~ To Nearest Sewer Service Line on Lot
Water Sample Collected By ~ ~ ~.~,~/~.~//~7 Date /F--//~,/~ ~'
Water Sample Test Results :> $:) '~.S'/~ (- ~'O ~1..7
Commentsg~'~ ~ ~/,~;~ ~3 I~ ~, ~ ~
SEt~rIC/~DDc~G TANK DATA
Standpipes~) ~_AiI?tight Caps~) _ Foundation Cleaq~ut
~pression o~ Ta~ (~] Date ~st P~d
P~ing/Mainte~an~ C~nt~et on File ~/~" ; f~ _.. ~'..
Holding Ta~ High-Wate= Ala~ (Y~- Tempts~y Holding Tank Permit (Y~
Separation Distance f~ ~ptic~ Tank:
To Water-Supply Well_
To Property Line /~
To Water ~/Service Line __~7_)
Course
To Building Foundatioq /~ !
To Disposal Field ~-
To Stream, Pond, Lake, or Major Drainage
Comments .~ ~j~,~ f~' Jt/~T/,f.7 A./~'I,'".~J' //.4 7" / AJT'~O ~tJ~r ,
Receipt ~
Date Paid:
Amount:
[Page 1 of 2] 2-15--84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~
Width of Field ~d3
Square Feet of Absorption A~ea ¢.~ '
Type of System Design
Length of Field ~
Dspth of Field ?
Gravel Bed Thickness
Standpipes P~esent~¢/W)
Depression ove~ Fiel ) D~te of Last Adequacy Test
Results of Last Adequacy Test /d~///7-'
Separation Distance from Absorption Field:
To Water-Supply W~ll /~']3 ~ To P~operty Line /O
To Building Foundation ~ ¢ ! To Existing or Abandor~d System cn
Lot ~30 ~ ; On Adjoining Lots .~o
To Wate~ Na~-~/Se~vice Line ~ /- To Cutbank( if present) ~J o e~J _~
To Stream/Pond/Lake/o~ Majo~ Drainage Course ,C~AD ~ ~'~
To Driveway, Parking A~ea, o~ Vehicle Storage A~ea ~5-LD
Co~nts ,~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Ala~mLevel at
Tested fox
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
Qff" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
~4eets
Ccmments
** Check Permitted ~ed~oomRating Against HAARequest
I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Si ned 8 ~ '8 ~ISIN~RIN~
Date
MOA No.
Knl/dS/s
[Page 2 of 2]
2-15-84
APPLi~ hiT FILLS OUT UPPER HAI ONLY
Property Owner
Maiming Address
I Phone
Zip Code ~'c~ .'~' 0 ~7.
Buyer
Address Zip Code
Lending Institution /~ ~ f4\ '~ /~' A /-~ ~ .4-) J~t ~..; /-" ~ C.,/ ~ ,~ l'/ l.E ]~ ~ ~'~ Phone
Address (~ C~ 2~' Zip Code 17 ~
Address Zip Code
Legal Description
Phone
Type of Residence
Single Family
~ Multiple Family No. of Bedroorr~-~ _
[] Other
Water Supply fO. (?~
[] Individual ' ~i~.,~.?·~d--,.: ATTACH WELL. LOG. A well Icg is required for all wells drilled since June 1975.
.1~ CommunltYPubllc Uglgy ~ .... For wells drilled prior to that date, give well depth (attach log if available),
Sewer Disposal
l~ear Individual Instalted: ('~) ,(,~ 7" / ~ ~C~ ~__
Individual
Public Utlg~y When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PRocEssING CAN BE INITIATED,
Time Time Time Time
[)ate Date Date Date
Inspector Inspector Inspector Inspector
Mt NICIPALIi f Oh- AN(.4~O~.A~E --
DEPT, OF H~ALTII &
ENVIRONMENTAL PROTECflON
AUB 3 'i ig';d3
Field Notes:
RECEIVED
( ) APPROVED BEDROOMS
} DISAPPROVE[)
CON DITIO~AL APPROVAL*
I DATE
'CONDITIONS OF APPROVAL
SolJs Rating
Date Sewer Installe~d
Well To Absorption Area
Well to Tank
Well Log Received
Septic Tank Size